Renal Profile of Patients with Cardiorenal Syndrome: Nephrology and Cardiology Department Experience of the University Hospital IBN SINA of Rabat

Introduction: Cardio-renal syndrome (CRS) is a complex pathophysiological entity affecting the heart and kidneys in which acute or chronic dysfunction of one organ can induce acute or chronic dysfunction of the other organ. Five types of CRS have been described. Methods: The study explored the prevalence and types of Cardiorenal Syndrome (CRS) at CHU Ibn Sina in Rabat. Over a year, 120 CRS patients were assessed, excluding those with end-stage chronic renal failure. We analyzed the epidemiological, clinical, therapeutic and evolutionary profile of these patients. Results: The average age of our patients is 67.8 ± 12 years, with extremes ranging from 39 years to 92 years. The sex ratio is 1.35. The different types of CRS types (1, 2, 4 and 5) were noted respectively in 28.4%, 20.8%, 5%, 45.8%, however, we did not note patients having CRS type 3. On the renal level, we noted acute renal failure (ARF) in 51.6% of patients, of whom 61.3% had functional ARF and 38.7% presented with acute tubular necrosis. Chronic renal failure (CRF) is found in 48.4% of cases, of which 39% are at stage III and 61% are at stage IV. The etiology of CKD is dominated by hypertensive nephropathy (72.4%) followed by diabetic nephropathy (60.3%). Therapeutically diuretics are administered in 51% of our patients. We used hemodialysis in 9.1% of patients who are resistant to diuretics. Vasoactive drugs are used in 9.5% of our patients. Mortality risk factors for patients with CRS are significantly related to advanced age, long hospital stay, type 1 CRS, re-hospitalization, acute pulmonary edema (APE), use of hemodialysis, right heart failure (RHF), valvulopathy and hemodynamic instability (OR = 1.15, p = 0.01;OR = 4.5, p = 0.03;OR = 5.2, p = 0.019;p Conclusion: CRS type 5 was most common, with hypertension and diabetes being primary causes of Chronic Kidney Disease. Mortality factors were linked to acute pulmonary edema, hemodialysis, right heart failure, valvulopathy, and re-hospitalization.

Epidemiological and Clinical Profile of Hypertensive Patients with Obstructive Sleep Apnea at CHU-B

Objectives: To detect obstructive sleep apnea syndrome (OSAS) in a population of hypertensive patients, using the Berlin questionnaire and to establish the epidemiological and clinical profile of patients. Patients and Method: This was a cross-sectional and analytical study, carried out from March to August 2019 at the CHU Brazzaville. Included are hypertensive patients followed as outpatients. The diagnosis of the OSAS was based on the answers to the Berlin questionnaire. Results: A total of 315 patients were included, including 210 women (64.9%). Prevalence of OSAS was 75.8% (n = 239). The average age of patients with sleep apnea was 58.5 ± 12.4 years with female predominance (64.9%). In the mixed analysis, the factors associated with (OSAS) were: occupation OR (2.56) 95% CI (1.15 - 5.69), obesity OR 7.50 (1.60 - 35.1) and abdominal obesity OR 2.36 CI 95% (1.36 - 4.08). Living standards were high in 59 cases (18.7 per cent). The medical history of previous hospitalization was present in 209 cases (66.3%), diabetes 95 (30.2%), and heart failure 57 cases (18.1%). Lifestyle patterns were: sedentary (n = 181;57.5%) alcohol consumption (n = 97;30.8%). On physical examination, overweight was noted in 96 cases (30.5%) and obesity in 91 cases (28.8%). The anomalies in the Berlin questionnaire were: snoring (n = 197;62.5%), waking fatigue (n = 127;40.3%), fatigue during the day (n = 97;30.8%). Conclusion: The prevalence of obstructive sleep apnea syndrome is high during arterial hypertension in our setting. Hence the need for sleep exploration through polysomnography, and prevention through the fight against the associated risk factors.

Prognostic Factors in Cardiorenal Syndrome Type 1: Retrospective Observational and Analytical Study

Introduction: Type 1 cardiorenal syndrome (CRS 1) is characterized by acute impairment of cardiac function leading to acute renal dysfunction. CRS1 is present in 25% of patients admitted for heart failure. The objective of our study is to analyze the epidemiological, clinical, therapeutic profile and the risk and prognostic factors of these patients. Materials and Methods: We identified 120 patients with cardiorenal syndrome (CRS) over a one-year period to determine the prevalence and risk factors for developing CRS 1. We analyzed the clinical, biological, and evolutionary profiles of patients with CRS 1 and determined the risk factors for the occurrence of acute kidney injury (AKI) as well as the mortality factors in these patients. Résultats: The average age of our patients with CRS1 is 58 ± 9 years, with a sex ratio of 1.4. The average eGFR of our patients is 35 ± 6.5 ml/min/1.73m2. Diabetes was found in 17% of our patients and hypertension in 14%. The etiology of cardiac impairment is predominantly acute coronary syndrome (ACS), followed by rhythm disorders. Renally, all our patients have acute kidney injury (AKI), with 86% having functional acute renal failure and 14% having acute tubular necrosis. Therapeutically, 50% of our patients are on diuretics, 42% receive beta-blocker treatment, and RAAS blockers are used in 29% of cases. Renal replacement therapy (RRT) sessions were required in 13.8% of cases. In univariate analysis, male gender, tachyarrhythmia, and hypertension are associated with the early onset of acute kidney injury (AKI). The use of diuretics, anemia, and low left ventricular ejection fraction (LVEF) are linked to a higher risk of developing CRS 1 (p = 0.021, p = 0.037, p = 0.010 respectively). In multivariate analysis, advanced age is significantly associated with increased mortality risk in CRS 1 patients (p = 0.030), while beta-blocker use is considered a protective factor (p = 0.014). Conclusion: Our study identifies several key factors associated with outcomes in type 1 CRS. Male gender, tachyarrhythmia, and hypertension are linked to early-onset AKI. The use of diuretics and the presence of anemia increase the risk of developing CRS1. Advanced age is significantly associated with higher mortality rates. Conversely, the use of beta-blockers appears to be protective in this patient population. .

The Efficacy of Tocilizumab for Takayasu Arteritis: Review of the Literatures

Takayasu arteritis is a large vessel vasculitis of the young women with giant cells and granuloma formation. The diagnosis and management of the disease are really not so easy because of the insidious onset and the difficulties in assessment of disease activity. Nearly 60% of the patients are corticosteroid resistant or dependent and relapses are very frequent during taper of the dose [1]. The novel biologic agents as Anti-TNF, Rutiximab and Tocilizumab provide acceptable response rates with low toxicity. Herein, we reviewed the efficacy of Tocilizumab in Takayasu arteritis.

Arterial Hypertension and Pregnancy about 72 Cases

Background: Hypertension is the leading cause of cardiovascular disease worldwide. Hypertensive disorders in pregnancy also constitute a major global health threat. There are different types of hypertension that can occur during pregnancy;with different mechanisms and consequences for mother and fetus. Objectives: To determine the frequency of hypertension (hypertension) during pregnancy. Document the risk factors for pregnancy-related hypertension. Review the material and fetal complications which determine the prognosis. Methods and Patients: This was a retrospective cross-sectional study from January 1 to June 30, 2022 in the Obstetrics and Gynecology Department of the Brazzaville Hospital and University Center. We noted 72 cases of hypertension among 1188 births admitted during the reference period. Hypertension was defined as blood pressure 40/90mmHg. Results: Hypertension was observed in 6% of those giving birth. The average age of the patients was 28 ± 8 years (range 15 to 39 years). The age group of 15 to 34 years was the most affected, 56 cases (778%). The risk factors were young age (15 - 34 years), late transfer of women in labor, 49 cases (68%). Primiparity, 33 cases (45.8%), absence of prenatal consultation, 7 cases (9.7%), hypertension, 8 cases (11%), twinning, 4 cases (5%), fetal macrosomia, one case (1.3%). Maternal complications recorded were: 21 cases of eclampsia (29%), 6 cases of left ventricular failure (8.3%), 5 cases of anemia (6.9%), 2 cases of retroplacental hematoma (2.8%), 1 case of HELLP syndrome, as much renal failure. Fetal and neonatal complications were 23 cases of prematurity (32%), 10 cases of acute fetal distress (14%), 4 cases of hypotrophy (5.6%). Eleven cases of death (15.3%) were: 3 in utero. B in the neonatal period.

Papulosa Nigra Dermatosis Another Factor Associated with Cardio-Vascular Diseases?

Objectives: To determine the correlation between dermatosis papulosa nigra (DPN) and cardiovascular disease (CVD). Patients and Method: A retrospective study was conducted between April 2022 and March 2023 in cardiology at Loandjili General Hospital. Were included all adult patients older than 18 years of age presenting with DPN, and divided into two groups according to the presence of CVD. Hypertension (HT), endomyocardial fibrosis, dilated and restrictive cardiomyopathy, chronic pulmonary heart, ischemic heart disease, stroke, and valvular heart disease were retained as CVD. Pregnant women, Peutz Jeghers syndrome and all dermatosis with cardiovascular manifestations were excluded. Studied variables were clinico-demographic, hereditary and behavioral. Results: A total of 55 patients were selected. There were 40 patients with CVD, 15 patients without CVD, 43 women (78.1%) and 12 men (21.8%). Mean age was 52 ± 12.6 years (extremes: 22 - 85 years). There was a significant difference between age and sex (P 0.05). There were 34 hypertensive patients, 10 patients with diabetes mellitus, 7 strokes, 2 endomyocardial fibrosis and 2 ischemic heart diseases. Periorbital location was representative was frequently found in the group with CVD. Hereditary and behavioral factors were involved in the development of DPN and CVD. There was a significant correlation between DPN and onset in childhood (P 0.05), between hypertension and use of medication (P 0.05), and between onset in childhood (P 0.05) and use of mercury containing soap (P 0.05). Conclusion: DPN predominates in young women. The occurrence of CVD depends on DPN location. Hereditary and behavioral factors associated with development of DPN are CVD factor risks.

心肌梗死接受直接PCI或溶栓治疗后出院前运动试验检查的预测价值:DANAMI-2的亚研究

Aims: To evaluate the prognostic importance of pre- discharge maximal symptom- limited exercise testing(ET) following acute myocardial infarction(AMI) in the era of aggressive reperfusion. Methods and results: In the DANAMI- 2(the second DANish trial in AMI) study, patients with ST- elevation AMI(STEMI) were randomized to primary angioplasty(PCI) or fibrinolysis. Of 1462 patients discharged alive, 1164(79.6% ) performed an ET. Primary endpoint was a composite of death and re- infarction. Patients randomized to fibrinolysis developed ST- depression to a greater extent than patients randomized to primary PCI(21.7 vs. 15.3% , P=0.007). Multivariable predictors of death and re- infarction included age, gender, diabetes, previous stroke, anterior AMI, randomization to fibrinolysis, and exercise capacity[risk ratio(RR) 0.82(0.72- 0.93); P< 0.001]. ST- depression was predictive of the clinical outcome[RR 1.57(1.00- 2.48); P< 0.05] in multivariable analysis, but stratified according to treatment groups there was a significant association between ST- depression and outcome in the fibrinolysis group[RR 1.95(1.11- 3.44); P< 0.05], but not in the primary PCI group[RR 1.06(0.47- 2.36); P=ns]. However, the P- value for interaction was 0.15. Conclusion: Exercise testing after contemporary reperfusion therapies for STEMI confers important prognostic information. Exercise capacity is a strong prognostic predictor of death and re- infarction irrespective of treatment strategy, whereas the prognostic significance of ST- depression seems to be strongest in the fibrinolysis- treated patients.

转院行直接经皮冠状动脉介入治疗的患者中自发性及介入治疗相关ST段改变的潜在意义:急性心肌梗死ST段监测研究(MONAMI研究)

Aims: In patients with ST-elevation myocardial infarction(STEMI) scheduled for primary percutaneous coronary intervention(primary PCI), acute risk-assessment may be valuable for tailoring of adjunctive therapy at the time of coronary intervention. The present study was designed to quantify pre-, per-, and post-interventional ST-changes, to evaluate whether a pre-specified continuous ST-monitoring classification provides potential prognostic information in the pre- and per-interventional phase, and to compare post-interventional ST-resolution parameters derived from continuous ST-monitoring and snapshot ECGs, respectively. Methods and results: In 92 STEMI patients, continuous ST-monitoring was initiated in the prehospital phase and continued during and 90 min following PCI. Patients were divided into three groups:(A) patients achieving spontaneous ST-resolution before PCI;(B) patients with preserved ST-elevation immediately before PCI and with no increase in ST-elevation during PCI; and(C) patients with preserved ST-elevation immediately before PCI and with increase in ST-elevation during PCI. Groups A(n=22), B(n=43), and C(n=27) differed in peak level of troponin-T(1.4, 4.7, and 7.2 μ g/L, P < 0.001), creatinine kinase MB isoenzyme(35, 150, and 325 μ g/L, P < 0.001), and N-terminal pro-brain natriuretic peptide(Nt-pro-BNP)(183, 175, and 269 pmol/L, P=0.084) during admission, and left ventricular ejection fraction evaluated within 2 h of PCI(0.53, 0.48, and 0.45, P=0.047) and after 3 months(0.58, 0.54, and 0.45, P < 0.001). Groups B and C also differed in time from first balloon inflation to ≥ 70% resolution of ST-elevation(14 vs. 42 min, P=0.002), whereas no differences were observed in traditional 90 min ST-resolution analysis or angiographically assessed parameters. Conclusion: STEMI patients transferred for primary PCI are heterogeneous with respect to pre- and per-interventional ST-changes, and a pre-specified ST-monitoring classification seems useful for stratification of patients at time of PCI into groups with low, intermediate, and high risk profile. Furthermore, post-interventional ST-monitoring indicates that traditional 90 min ST-resolution analysis may have limited value in the era of primary PCI.

猝死家族史是原发性室颤的重要危险因素:一项针对急性心肌梗死患者的病例对照研究

背景:原发性室颤(VF)是心肌梗死急性期的主要死因。对具有原发性VF风险患者的识别尚待提高。方法和结果:进行此项病例对照研究以确定初发ST段抬高型心肌梗死(STEMI)患者发生原发性VF的独立危险因素。试验纳入330例原发性VF存活者(病例组)和372例对照者,排除早期梗死或有器质性心脏病征象的患者。

心肌梗死患者应当吸氧吗？根据生理机制并且没有吸氧有害的证据：应该吸氧

近期发表的一篇系统性综述显示，吸氧不能减轻急性心肌梗死患者的胸痛症状或改善其生存率，反而可能有害。毫无疑问，这一结论会引起医学界的关注，但这篇文章的研究结果是否可靠，它对临床实践又有何意义，值得深入分析。

不同文化传统的国家中饮酒模式与缺血性心脏病的关系：心肌梗死前瞻性流行病学研究（PRIME研究）

目的探讨在两个生活方式不同的国家（北爱尔兰和法国）中，饮酒方式对缺血性心脏病发生的影响。